肾泄者，五更溏泄也。肾虽水脏，而中有元阳，为脾土之母。又肾者主蛰，封藏之本，
而开
窍于二阴，肾阳既虚，即不能温养于脾，又不能禁固于下，故遇子后阳生之时，其气不振，
阴寒反胜，则腹鸣奔响作胀，泻去一二行乃安，积月不愈，或至累年。此病藏于肾，宜治下
而不宜治中者也。
五味子散
五味子（一两） 吴茱萸（半两，细粒绿色者）
上二味，同炒香熟为度，细末每二钱，陈米饮下。
许氏云∶顷年有一亲识，每五更初欲晓时，必溏泄一次，如是数月。有人云∶此名肾泄
，感阴气而然，得此顿愈。
四神丸
肉豆蔻 五味子（各二两） 补骨脂（四两） 吴茱萸（浸炒，一两）
上为末，生姜八两，红枣一百枚，煮熟取枣肉和丸如梧子大，每服五七十丸，空心或食
前白
汤下。一云∶夜食前更进一服。盖暖药虽平旦服之，至夜力已尽，无以敌一夜阴气之故也。
《澹寮》无五味、吴萸，有茴香一两，木香半两。一方去五味、吴萸、入神曲、麦芽。
按∶五更溏泄，不独肾虚一端，酒积、食积、寒积，皆作此病。概与温肾，非其治矣。
食积
、酒积，治法详久泄，吞红丸子，或单服曲 枳术丸。寒积者，积寒在脾肾，宜魏氏椒朴丸
。
椒朴丸
益智仁（去壳，炒） 川椒（炒出汗） 川浓朴（姜制） 陈皮 白干姜 茴香（炒，各等分）
上用青盐等分，于银石器内，以水浸前药，慢火煮干，焙燥为末，酒糊丸如梧子大，每
服三十丸，加至四十丸，空心盐汤温酒任下。
伤酒者，湿热在脾，宜理中汤加干葛、黄连，或葛花解酲汤，吞酒煮黄连丸。
饮食过多，脾胃之气，不能运化，其人必嗳气如败卵，宜治中汤加砂仁半钱，吞红丸子
，或单服曲 枳术丸。
肾泄，是指五更时分发生的稀溏腹泻。肾脏虽然属于水脏，但其中蕴含元阳，是脾土的母脏（即先天之本滋养后天之本）。另外，肾主蛰伏封藏，是封藏的根本，且开窍于前阴和后阴。如果肾阳虚弱，就不能温养脾土，也不能固摄下部，因此在子时之后阳气初生之时，正气不振，阴寒之气反而亢盛，导致腹部鸣响、奔豚感、胀满，泻下一两次后感到舒适，病情持续数月不愈，甚至延续数年。这种病根在肾，应当治疗下焦（肾），而不宜单纯治疗中焦（脾胃）。
五味子散
五味子（一两） 吴茱萸（半两，选用颗粒细小、颜色绿色的）
以上两味药，共同炒至香气熟透，研成细末。每次服用二钱，用陈年米汤送服。
许氏说：近年有一位亲友，每当五更初天将亮时，必定发生一次稀溏腹泻，如此持续了几个月。有人说：这名叫肾泄，是因为感受阴气所致，服用此方后立即痊愈。
四神丸
肉豆蔻 五味子（各二两） 补骨脂（四两） 吴茱萸（浸泡后炒制，一两）
以上药物研为细末，取生姜八两，红枣一百枚，煮熟后取出枣肉，与药末混合制成梧桐子大小的丸剂。每次服用五七十丸，空腹或饭前用白开水送服。另一种说法是：夜间饭后再加服一次。因为暖性药物虽然在清晨服用，到了夜晚药效已经耗尽，无法抵御一整夜的阴气。《澹寮》方中没有五味子和吴茱萸，有一两小茴香，半两木香。另一处方去掉五味子、吴茱萸，加入神曲和麦芽。
按语：五更稀溏腹泻，不仅仅是肾虚一种原因，酒积、食积、寒积，都会导致此类病症。一概给予温补肾阳的方法，不是正确的治法。
对于食积、酒积，治疗方法详见久泄章节，可吞服红丸子，或单独服用曲枳术丸。如果是寒积，即寒邪积聚在脾肾，适宜使用魏氏椒朴丸。
椒朴丸
益智仁（去壳，炒制） 川椒（炒至出汗） 川浓朴（姜汁炮制） 陈皮 白干姜 茴香（炒制，各等分）
以上药物取青盐等量，在银器或石器内，用水浸泡上述药物，用慢火煮至水干，焙燥后研为细末，用酒糊制成梧桐子大小的丸剂。每次服用三十丸，增至四十丸，空腹时用盐水或温酒任意送服。
饮酒过度者，湿热蕴结在脾，适宜使用理中汤加干葛、黄连，或者葛花解酲汤，吞服酒煮黄连丸。
饮食过多，脾胃之气不能运化，此人必然嗳气有腐败鸡蛋的气味，适宜使用治中汤加砂仁半钱，吞服红丸子，或单独服用曲枳术丸。
Shen Xie (Kidney Diarrhea) refers to loose stools occurring during the fifth watch of the night (approximately 3-5 AM). Although the Kidney is a Water organ, it contains Primordial Yang, which serves as the mother of Spleen Earth (i.e., congenital foundation nourishes acquired foundation). Furthermore, the Kidney governs hibernation and sealing/storing; it is the root of consolidation. Its orifices open at the two yin passages (anterior and posterior). If Kidney Yang is deficient, it cannot warm and nourish the Spleen, nor can it secure the lower jiao. Therefore, when Yang begins to generate after the Zi hour (11 PM - 1 AM), Qi fails to rise, and Yin-Cold prevails. This leads to abdominal borborygmus, a sensation of Qi rushing upward (Ben Teng), and distension. Relief is felt only after one or two bowel movements. The condition persists for months or even years. Since this disease resides in the Kidney, treatment should focus on the lower jiao rather than solely on the middle jiao (Spleen/Stomach).
Wuweizi San (Schisandra Powder)
Schisandrae Fructus (Wuweizi, 五味子) (1 liang) Evodiae Fructus (Wuzhuyu, 吴茱萸) (0.5 liang, select small, green grains)
The above two herbs are stir-fried together until fragrant and fully cooked, then ground into a fine powder. Take 2 qian per dose, administered with aged rice water.
Xu stated: In recent years, an acquaintance suffered from loose stools once every morning just before dawn for several months. Someone suggested: This is called Shen Xie (Kidney Diarrhea), caused by invasion of Yin Qi. Taking this formula resulted in immediate cure.
Sishen Wan (Four Spirits Pill)
Myristicae Semen (Roudoukou, 肉豆蔻) Schisandrae Fructus (Wuweizi, 五味子) (each 2 liang) Psoraleae Fructus (Buguzhi, 补骨脂) (4 liang) Evodiae Fructus (Wuzhuyu, 吴茱萸) (soaked and stir-fried, 1 liang)
Grind the above herbs into a powder. Take 8 liang of fresh Ginger and 100 Red Dates, boil until cooked, remove the flesh of the dates, and mix with the powder to form pills the size of Sophora seeds. Take 50-70 pills per dose, administered with plain warm water on an empty stomach or before meals. Another method suggests taking an additional dose before bed. This is because although warming herbs taken in the morning may seem effective, their power dissipates by night, leaving them unable to counteract the Yin Cold of the entire night. The *Danliao* prescription excludes Wuweizi and Wuzhuyu but includes 1 liang of Foeniculum Vulgare (Huixiang, 小茴香) and 0.5 liang of Aucklandiae Radix (Muxiang, 木香). Another variation removes Wuweizi and Wuzhuyu, adding Massae Medicatae Fermentatae (Shenqu, 神曲) and Hordeum Fructus Germinatus (Maiya, 麦芽).
Note: Loose stools at the fifth watch are not exclusively due to Kidney deficiency. Alcohol accumulation, Food stagnation, and Cold accumulation can all cause this condition. Applying warming Kidney tonics indiscriminately is incorrect.
For Food stagnation and Alcohol accumulation, refer to the treatment of chronic diarrhea: take Hongwanzi (Red Pills) or Qu Zhizhu Wan (Qu Zhizhu Pills). For Cold accumulation, where cold pathogens accumulate in the Spleen and Kidney, Wei’s Jiaopu Wan (Pepper and Magnolia Bark Pill) is appropriate.
Jiaopu Wan
Alpiniae Oxyphyllae Fructus (Yizhiren, 益智仁) (shelled, stir-fried) Zanthoxyli Fructus (Chuanjiao, 川椒) (stir-fried until "sweating") Magnoliae Officinalis Cortex (Chuanhoupo, 川厚朴) (processed with ginger juice) Citri Reticulatae Pericarpium (Chenpi, 陈皮) Zingiberis Rhizoma Recens (Baiganyjiang, 白干姜) Foeniculum Vulgare (Huixiang, 茴香) (stir-fried, equal parts)
Take equal parts of Halitum (Qingyan, 青盐). Place the above herbs in a silver or ceramic vessel, soak them in water, and simmer slowly over low heat until the water evaporates. Dry the mixture, grind into powder, and bind with wine paste to form pills the size of Sophora seeds. Take 30 pills initially, increasing to 40 pills. Administer on an empty stomach with salt water or warm wine.
For alcohol injury, where damp-heat accumulates in the Spleen, use Lizhong Tang (Regulate the Middle Decoction) modified with Puerariae Radix (Gange, 干葛) and Coptidis Rhizoma (Huanglian, 黄连), or Gehua Jiexing Tang (Kudzu Flower Decoction to Resolve Intoxication), swallowing Jiuzhu Huanglian Wan (Alcohol-Boiled Coptis Pills).
For excessive food intake, where Spleen and Stomach Qi fail to transform and transport, the patient will likely belch with a smell resembling rotten eggs. Treat with Zhizhong Tang (Regulate the Middle Decoction) plus 0.5 qian of Amomi Fructus (Sharen, 砂仁), swallow Hongwanzi (Red Pills), or take Qu Zhizhu Wan (Qu Zhizhu Pills) alone.